Abstract 106: Submersion Injury and Cardiac Arrest in Children: A 10-Year Experience
Submersion injury (SI) is a significant cause of mortality in children. A retrospective study was performed to identify factors associated with survival. Children admitted with SI to a university-affiliated PICU in the 10 years ending 2010 were identified. We abstracted patient demographics, circumstances at SI, resuscitation, and ICU therapies. The primary outcome was hospital survival. Univariate and multivariate regression was performed. A p<0.01 was regarded as significant. The 48 patients had a median(IQR) age of 9.2(2.6-12.6) years. 34(71%) were male, 34(71%) events occurred in pools, 7(15%) each in bathtubs and lakes. 7(15%) children had cold water drowning. The mean (SD) submersion time was 6.5(8.3) min. 36(75%) children had cardiac arrest. ROSC occurred after a median (IQR) of 37(5-53) min. The first identified rhythm was asystole/PEA in 14 (29%), VT/VF in 8 (17%). 22(46%) patients had a perfusing rhythm at first evaluation (4 unknown), 7(15%) had respiratory resuscitation only. There were 29(60.4%) hospital survivors. Univariate analysis identified first identified cardiac rhythm, number of doses of epinephrine, need for CPR at scene, reactivity of pupils at scene and at 24 hrs, need for continuous infusion of vasoactive drugs, time to ROSC, initial pH and base excess, motor score at scene, and adverse EEG findings during ICU stay were significantly associated with survival. Cold water SI was not associated. All but one patient with ROSC of >20 min (n=19) died. ROSC of <20 min (n=16) or no cardiac arrest (n=13) had 97% survival. In multivariate analysis ROSC, epinephrine doses for resuscitation and vasoactive drug infusion requirement was significantly associated with survival.
Discussion: This 10 year retrospective review of 48 children we found a high frequency of SI occurring in pool settings, and 75% received chest compressions. Time to ROSC was independently associated with mortality, suggesting that this has greatest prognostic use for clinical decision-making. Patients with ROSC <20 min have a good prognosis independent of other factors. This may help inform decisions about the duration of pre-ICU CPR.
- © 2011 by American Heart Association, Inc.